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hrsa

participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



NEWS AND NEW DEVELOPMENTS



New treatment rules for rifabutin in TB co-infection

Acquired Rifamycin Resistance in Persons with Advanced HIV Disease BeingTreated for Active Tuberculosis with Intermittent Rifamycin-Based Regimens [CDC MMWR 2002;51:214]: This is an announcement of the CDC sponsored Tuberculosis Trials Consortium (TBTC Study) 23, which was a single arm trial of rifabutin-based therapy given twice weekly for treating HIV-tuberculosis co-infection. The Data and Safety Monitoring Board met on March 6, 2002 and suspended further enrollment due to the observation that five of 156 participants with failure or relapse in the tuberculosis treatment had acquired rifamycin resistance. All five had CD4 cell counts less than 60/mm3 and 4 of the 5 were receiving twice weekly therapy during the inductionphase (the first two months). Other studies have also shown the acquisition of rifamycin resistance with once or twice weekly rifampin in patients with low CD 4 cell counts (Lancet 1999;353:1843; CID 1998;26:1148). The conclusion was that more data are necessary, but until that time the CDC recommends that persons with HIV-TB co-infection with a CD4 cell count less than 100/mm3 should receive daily therapy during the first two months and this agent should be given daily or three doses/week during the continuationphase. For persons already receiving twice weekly therapy with rifamycin, treatment should be daily or three times/week.


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